Patient Service Representative Insurance Specialist

Job Description

The Patient Service Representative (PSR) serves as the first connection between Intermountain and patients. This role embodies Intermountain values and focuses on establishing collaborative relationships with patients and fellow caregivers to deliver the highest level of customer/patient satisfaction. The PSR ensures a superior customer experience by identifying and resolving patient needs related to patient intake and care, which may include greeting and checking-in/out patients, as well as verifying information supplied by patients.

The Patient Service Representative (PSR) serves as the first connection between Intermountain and patients. This role embodies Intermountain values and focuses on establishing collaborative relationships with patients and fellow caregivers to deliver the highest level of customer/patient satisfaction. The PSR ensures a superior customer experience by identifying and resolving patient needs related to patient intake and care, which may include greeting and checking-in/out patients, as well as verifying information supplied by patients.

We are seeking an organized and compassionate Patient Service Representative to join our healthcare team. If you're passionate about providing exceptional care and want to work in an environment that values growth, we’d love to hear from you!

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• Entry Rate: $18.31 - $23.80 depending on experience
• Benefits Eligible:
  Yes, check them out here
• Shift Details:
  Full-time, 40 hours per week

• Review and validate patient insurance coverage prior to appointments.
• Manage daily insurance verification workflows for Connect Care clinics
• Resolve eligibility discrepancies and coordinate corrections with registration and patient access teams.
• Monitor payer-specific requirements and coverage limitations for telehealth services.

• Investigate denied and delayed claims and identify root causes.
• Coordinate corrections related to NPI enrollment, modifiers, place of service, coding issues, and payer configuration errors.
• Track denial trends and partner with Revenue Cycle, Coding, and Payer Contracting teams to implement solutions.
• Manage Revenue Guardian reports, billing work queues, and follow-up activities to improve clean claim rates.

• Maintain provider enrollment tracking for commercial, Medicare, Medicaid, and managed Medicaid plans across multiple states.
• Coordinate provider credentialing and licensing readiness for Connect Care expansion initiatives.
• Support multi-state payer enrollment projects and maintain operational tracking tools for provider readiness.
• Serve as an operational liaison between Connect Care, Credentialing, Enrollment, Payer Contracting, and clinic leadership teams.

• Work payer claim work queues and resolve claim submission issues.
• Manage claim corrections and coordinate with coding teams regarding CPT codes, modifiers, and telehealth billing requirements.
• Research payer payment issues and implement workflow improvements to reduce unnecessary denials.
• Monitor reimbursement performance and support billing optimization efforts.

• Coordinate payer authorization requirements, including Medicaid, Medicare Advantage, Tricare, and commercial plans.
• Track authorization status and proactively address barriers to care delivery.
• Ensure compliance with payer-specific referral and authorization requirements.

• Partner with Epic, DTS, Revenue Cycle, Patient Access, and Operations teams to resolve system-related billing and insurance issues.
• Identify Epic build requirements affecting claims reimbursement and telehealth workflows.
• Assist with development of operational reports, payer tracking tools, and workflow documentation.
• Support implementation of new virtual care programs and expansion into new states or payer networks.

• Manage insurance and charge-entry workflows for Key Care visits.
• Support lactation, behavioral health, urgent care, nutrition, and specialty telehealth programs with reimbursement guidance and claim resolution.
• Coordinate coding and billing readiness for new service launches.

• Six months of customer service experience involving…